Individual
MRS. NICHOLE RENE' JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
2 E. MAIN STREET, SHAWNEE, OK 74801
(405) 826-6441
(405) 878-0162
Mailing address
2 E. MAIN STREET, SHAWNEE, OK 74801
(405) 826-6441
(405) 878-0162
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD 873
OK
Other
Enumeration date
10/05/2006
Last updated
07/09/2007
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